Acute backache is one of the commonest discomforts that afflict aging humanity.  Besides aging, poor back hygiene and unhealthy life styles are the most common inciting causes.  Other causes such as back trauma, osteoporosis with compression vertebral fractures, arthritis of the spine and facet joints, etc. will not be discussed here.
      Unlike chronic backache, acute backache comes on suddenly, lasts a few days to a few weeks, and then spontaneously resolves.  It may happen after minor activities such as gardening, lifting, straining, coughing, or it may come after prolonged overloading such as caring for a new baby, standing or sitting too long at a new job, or driving long distances without walking intermissions.  Most of the time sufferers cannot exactly pin the cause of their backache to any single activity and often a minor move, an innocent bend, or a simple sneeze may bring it on.
      The most common source of acute backache is the lumbar disc, which acts like a pillow to separate the vertebrae, provide shook absorption, and enhance mobility.  It is the largest organ in the body with no blood supply and therefore it is totally dependant upon exercise for its nourishment and healing, which is why prolonged bed rest has an opposite and detrimental effect.  Just like a pillowcase holds cotton inside of it, the disc membrane holds jelly within its confines; and just like a pillowcase can tear and leak its cotton to the outside, so can a disc membrane crack and leak its jelly into the surrounding tissues.  It just happens that the jelly contained inside the disc is the most irritating substance in nature, much more irritating than acid or fire.  Consequently, a microscopic leak may cause a great amount of tissue inflammation.  Such microscopic leaks, which are not visible on X-ray or MRI, are the commonest causes of acute backaches.
      As we age, the disc membrane becomes stiffer and thinner, which renders it more prone to cracks and leaks.  Moreover, since the disc has no blood supply its cracks heal poorly, which is why they tend to re-crack under overload conditions.  Hence, strict back hygiene that avoids overload and encourages exercise is the most important preventive strategy against recurring acute backaches.
      When backache unexpectedly hits, a diagnosis is necessary to separate the common backaches due to innocent disc leaks from the occasional ones due to serious disc ruptures.  This can be accomplished clinically in most situations.  If the pain is localized to the back or if it does not radiate down the leg beyond the knee, then it is most likely a self-limited leak that can be handled medically without diagnostic MRIs or X-rays.  If, however, the pain radiates to the foot or causes muscle weakness and if it does not respond to medical therapy it may require special diagnostic studies to determine if surgery will be needed.  Nevertheless, urgency is seldom necessary because most backaches that radiate to the foot respond well to simple medical treatments, which should always be tried before resorting to expensive diagnostic studies.
      The lumbar MRIs or other X-rays are overused, financially wasteful, often harmful, and seldom helpful.  They should not be routinely used to diagnose the cause of acute backache partly because the cause is often microscopic and partly because the MRI is too sensitive and invariably shows multiple abnormalities that are not related to the clinical problem.  Chasing such irrelevant abnormalities is often harmful physically, emotionally, and financially.  Multiple studies comparing the MRIs of those with and without backache have shown no difference.  The only real indication for an MRI therefore is to determine if the backache is surgical.  Consequently, it should not be done unless medical therapy has failed and the pain continues to cause significant disability that justifies surgical options.
      The main treatment of acute backache is anti-inflammatory medications plus pain pills when the pain is too great.  Physical therapy, manipulation, massage, etc. have shown no advantage in clinical studies.  Maintaining normal life activities in spite of the pain is much better than inactivity or bed rest because activity facilitates healing while inactivity delays it.
      The anti-inflammatory medications are of two types.  The common variety, aspirin-like drugs, which include ibuprofen and naproxen are often tried with good results.  When they fail, a short course of cortisone such as Dexamethasone 12 mg daily for 3-5 days usually gives prompt relief.
      Education about back hygiene to prevent recurrent spells of acute backache is essential.  Unsupported bending, stooping, or lifting; prolonged standing or sitting uninterrupted by walking intermissions; smoking and heavy drinking; overweight, lack of exercise, and unfit life styles should all be avoided.  Daily exercises such as walking, aerobics, and swimming help nourish the disc and promote healing.  Smoking and bed rest starve the disc and retard healing to the point that disc surgeons usually refuse to operate on heavy smokers or those on prolonged bed rest because the surgical outcomes are often poor.